Racial and Ethnic Differences in ED Analgesia Among Injured Children Transported Via EMS

Objectives: Pain management remains suboptimal across the prehospital and the emergency department (ED) settings. Racial and ethnic disparities in the timing of analgesia among children transported to EDs via emergency medical services (EMS) are not known. We investigated disparities in the timing of ED pain management for injured children transported by EMS. Methods: We conducted a secondary analysis of a multicenter prospective observational study of children transported via EMS to 10 pediatric EDs. We analyzed the timing of ED analgesia for injured children by race and ethnicity: non-Hispanic White (NH-White), non-Hispanic Black (NH-Black), Hispanic, and Other or Multiracial. We stratified doses of ED analgesia by opioids, nonopioids, nonsteroidal anti-inflammatory drugs, and other analgesic medications regardless of routes of administration. Results: Among 480 eligible injured children, 353 (73.5%) received ED analgesia and 150 (31.3%) received opioid analgesia in the ED after EMS transport. The median time to first administration of any ED analgesia was 39 minutes (range, 2 min to 6 h). Hispanic children received their first dose of any ED analgesia 55 minutes (minimum-maximum, 2 to 369) into their ED care, compared with 38 minutes (4 to 379) for NH-Black, 37 minutes (4 to 345) for NH-White, and 32 minutes (9 to 188) for children of Other or Multiracial groups (P = 0.0148). There were no statistical differences in the time to first ED opioid analgesia by race and ethnicity (P = 0.3270). Patients with long bone fractures (hazard ratio: 1.56, 1.18-2.06) and those who had received EMS opioids (1.43, 1.07-1.91) were more likely to receive both any analgesia and opioid analgesia in the ED. Conclusions: Among injured children across the country transported by EMS to pediatric EDs, there were race and ethnicity differences with respect to time to any ED analgesia; however, no delay for ED opioids. Further research is needed to understand and mitigate potential root causes of these disparities.